CMS Releases IPPS Proposed Rule for FY 2025

The Centers for Medicare and Medicaid Services (CMS) released an unpublished proposed rule April 10 that would update Medicare payment policies for hospitals under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital Prospective Payment System (LTCH PPS) for fiscal year 2025. The proposed rule is scheduled for publication in the Federal Register May 2.

CMS proposes a $3.2 billion (2.6%) increase in operating payment rates paid under the IPPS for general acute care hospitals that successfully participate in the Hospital Inpatient Quality Reporting Program and are electronic health record users. Additionally, the agency expects to increase the LTCH PPS standard federal payment rate by 2.8%.

In addition, the proposed rule contains several provisions relevant to the blood and biotherapies community. First, CMS proposes to increase the new technology add-on payment percentage from 65% to 75% for gene therapies used to treat sickle cell disease. The increase would take effect in 2025 and end after the 2- to 3-year newness period of any such gene therapy. CMS previously announced that sickle cell disease would be the focus of a new Cell and Gene Therapy Access Model, which aims to improve health outcomes and increase access to cell and gene therapies.

Additionally, to help curtail shortages of essential medicines, CMS is proposing a separate payment under the IPPS for small, independent hospitals to establish and maintain a buffer stock of essential medicines for use during future shortages.

CMS released a fact sheet that summarizes key provisions of the proposed rule. The agency is accepting comments on the proposed rule through June 10.